Provider Demographics
NPI:1730449562
Name:GANN, LIBBY K (RD, LD)
Entity type:Individual
Prefix:
First Name:LIBBY
Middle Name:K
Last Name:GANN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 N YORK ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3123
Mailing Address - Country:US
Mailing Address - Phone:918-913-9109
Mailing Address - Fax:918-913-9112
Practice Address - Street 1:928 N YORK ST
Practice Address - Street 2:SUITE 20
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3123
Practice Address - Country:US
Practice Address - Phone:918-913-9109
Practice Address - Fax:918-913-9112
Is Sole Proprietor?:No
Enumeration Date:2012-05-27
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered